By Britta Dinsmore, Ph.D., ORM Psychologist
If someone close to you is struggling with infertility, you probably have some understanding of the feelings of grief and loss they have in relation to not having a child. What may be less obvious are the many different layers and types of grief that can be associated with fertility challenges. In this article, let’s uncover some of these challenges hidden in the depths of infertility.
LOSS OF THE ENVISIONED IDEAL
The fun and excitement of starting a family
Couples often anticipate trying to start a family as a joyful time and the beginning an exciting next chapter in life. When efforts to conceive are unsuccessful month after month, the sense of fun and excitement may be replaced with feelings of fear, guilt, shame, or anger. If fertility treatment is part of the picture, there may also be a sense of loss in terms of conception not being the private, personal, intimate, and non-medicalized event that they had hoped for.
Celebrating and enjoying the pregnancy
Pregnancy is often anticipated as a special time, involving positive experiences such as surprising close friends and family members with pregnancy news, shopping for the baby, or having a baby shower. For people with fertility challenges, pregnancy may seem like a fragile and precarious state and it may not only be difficult to let down one’s guard and actually enjoy or celebrate it, but there may be a sense of “superstition” about doing so that may result in foregoing such experiences altogether.
LOSSES IN THE PARTNERSHIP
Sexual intimacy for the sake of pleasure, intimacy, and connection
Fertility challenges can “highjack” a couple’s sexual relationship. When there is pressure to have intercourse according to a calendar rather than according to interest and desire, sexual intimacy can begin to feel more like an obligation than a source of intimacy, pleasure, and connection.
Being able to share in the joy of others’ pregnancies or young children-
For a person struggling with infertility, it can be difficult to celebrate, enjoy, and actively participate in the pregnancies and parenthood journeys of close friends and family members. When others share pregnancy news or talk about pregnancy or parenthood, feelings of resentment, jealousy, anger, or loss may be triggered. Such feelings may be experienced as “out of character” and in contradiction to how the person wants to feel or how they think they “should” be able to respond. This may prompt feelings of shame or guilt for not being able to be a “better” friend, sister, etc.
Enjoyment of celebrations, traditions, and rituals that typically foster connection and mark major milestones in life-
Attending events that highlight pregnancy or children (such as baby showers or holiday gatherings) can be quite painful. Such events can be a painful reminder of an unrealized dream, as well as a reminder of the passage of time without success in having a child.
Connection and closeness in relationships; loss of comfort and ease in social situations-
Even common, everyday gatherings can be challenging if the majority of others in attendance are either expectant or current parents and the focus of the conversation gravitates to pregnancy or parenthood. For a person struggling with infertility, such conversations are not only typically painful, but they may also prompt feelings of self-consciousness or being left out, because they may not feel they have anything to contribute to the conversation or that they can’t relate. This can lead to withdrawal from family and friends. Social withdrawal may also be prompted by a desire to avoid insensitive comments, judgment, lack of understanding and empathy, or unsolicited advice.
Sense of health, vitality, and physical capability
Infertility may be one’s first encounter with a significant health issue or physical limitation. It can be difficult to accept and adjust to the idea that, in spite of overall good health and a healthy diet and lifestyle, one’s fertility may be on the decline. This may require a re-working of one’s sense of self, in order to incorporate this newly recognized reality.
Sense of masculinity/femininity
Men with diagnosed male factor issues often report feeling like “less of a man” because virility is so closely associated with masculinity in our culture. Similarly, when female factor issues are diagnosed, women tend to struggle with feelings of inadequacy, defectiveness, or a sense of not being a “true woman” because fertility and womanhood have traditionally been so strongly linked.
Sense of efficacy in one’s life
People struggling with fertility challenges may struggle with the loss of control they have over such an important life goal. This may be one of the first challenges that the person hasn’t been able to be resolved by working harder or working “smarter.” This can be challenging to one’s sense of identity as a capable and successful person and can also lead to a sense of “learned helplessness,” if one’s efforts seem to repeatedly have no impact on the outcome.
LOSS OF CONTROL AND PREDICTABILITY
Ability to effectively make short and long-term plans
It is difficult to plan work schedules, travel plans, personal vacations, and day-to-day commitments around a treatment calendar, but bigger life decisions can also be hard to make and plan for when fertility treatment is part of the picture and there is uncertainty about when the next treatment cycle will be.
Predictability in making major life decisions
Not having a sense of when one might finally be pregnant or might finally be successful in having a baby can make it quite difficult to make major life decisions about things such as pursuing additional training or education, seeking work promotions or opportunities, exploring career changes, moving to a new area, buying a home, or making major purchases. This difficulty can be paralyzing and can contribute to the sense of being stuck while others are moving forward in their lives.
Ways to Support
Having a better understanding of the nature and complexity of some of the various secondary losses associated with infertility may make it easier to reach out or respond to friends or loved ones struggling with fertility challenges in a more supportive and empathic way. Below are some “Do’s and Don’ts” for family and friends.
- Ask your friend or loved one about how you can best support them. People vary in terms of whether they like others to ask how they are feeling and doing in relation to their family building efforts or, instead, prefer to be allowed to initiate the topic when they feel like talking about it.
- Do your best to be understanding and supportive of the choices your friend or loved one makes about attending holiday events, family gatherings, or other social occasions. This doesn’t mean your friend or loved one is being selfish or doesn’t value their relationships, nor does it mean it will be that way indefinitely. Taking a step back from certain events and gatherings just may be something they need to do during this time to take care of themselves.
- Try to be patient if your friend and loved one has to change or cancel plans—consider that this may be due to unanticipated changes in her fertility treatment. Also, fertility treatment is a fairly involved process and takes up a lot of time and energy. Your friend and loved one may be less involved simply because they have more demands on their time.
- Be considerate about sharing pregnancy news. It can be very difficult for people struggling with infertility to be caught off guard by a “surprise” announcement in a group setting. Consider giving your friend or loved one a “heads up” ahead of time.
- Minimize complaining about challenges related to pregnancy or parenting.
- Be cautious about sharing anecdotes about what worked for someone else you know (i.e. “my co-worker and her husband started the process of adoption and wouldn’t you know it, they became pregnant just after they were chosen by a birth mother…”)
- Don’t ask someone who is childless when they are going to have children or assume they don’t want to have children. Similarly, don’t ask someone who has a child when they are going to have their next child or assume they don’t want more children.
- Whether in group settings or 1:1, avoid over-focusing on the topics of pregnancy and parenthood and try to include topics your friend or loved one can contribute to and feel a part of. Make a point of asking your friend or loved one about their interests and accomplishments outside of the goal of starting a family, as well as sharing your own experiences and happenings outside of pregnancy and/or parenting.
- Try not to take it personally or hold it against your friend or loved one if they are not as “present” or involved in your pregnancy as you would have expected/wished or doesn’t spend as much time connecting with or getting to know your young children as you would have hoped. It may be painful to be “up close’ to something they long for so much. And, remember, not being as involved in this part of your life is likely to feel like a loss for your friend or loved one, too.
- Don’t make assumptions about what family building options your friend or loved one has or has not already considered. It is likely they have already spent a lot of time and energy considering a variety of options, none of which are probably as simple and inexpensive as they might seem to be to an outsider.
- Don’t give unsolicited advice. Under no circumstances, tell your friend or loved one that the problem is that they are worrying too much and that they need to “just relax.” For one thing, in many cases there are objective medical findings that are contributing to the couple’s difficulty conceiving and being more relaxed will have zero chance of making a single bit of difference. Secondly, this kind of advice suggests that the person/couple is at fault and has caused their fertility challenges—-not exactly a supportive sentiment.
- Don’t ask whose “fault” it is that they are having trouble conceiving.
- Don’t tell your friend or loved one “how lucky [they] are” that they get to sleep in on the weekends or travel or have plenty of time to exercise. He or she would likely gladly give any of these perks up to have a child.
Britta Dinsmore, Ph.D. is the Clinical Director of Psychological Services at ORM Fertility. In addition to serving in this leadership role, she provides counseling, consultation, and support to people at all different stages of family building and also conducts psychological evaluations of donor and gestational carrier candidates.